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Title: Infection Prevention eBug Bytes October 2015


1
Infection PreventioneBug BytesOctober 2015
2
Drug-resistant E. coli continues to climb
in community health settings
  • Drug-resistant E. coli infections are on the rise
    in community hospitals, where more than half of
    U.S. patients receive their healthcare, according
    to a new study from Duke Medicine. The study
    reviewed patient records at 26 hospitals in the
    Southeast. By examining demographic information,
    admission dates and tests, the researchers also
    found increased antibiotic-resistant infections
    among community members who had limited exposure
    to health care settings, but who may have
    acquired the bugs through some other
    environmental factors. The study data were
    gathered through the Duke Infection Control
    Network (DICON), which helps community hospitals
    and surgery centers across the U.S. prevent
    infections using education and evidence-based
    strategies. The data showed that between 2009 and
    2014, the incidence of drug-resistant
    extended-spectrum beta-lactamase (ESBL)-producing
    E. coli doubled from a rate of 5.28 incidents per
    100,000 patients to a rate of 10.5 infections per
    100,000. The median age of patients infected with
    E. coli was 72 years. Looking at the timing of
    patients' infections and when they were last in
    contact with a healthcare setting, the
    researchers also discovered that people with
    infrequent healthcare contact were acquiring the
    superbug at an even faster rate than patients who
    have regular contact with hospitals or nursing
    homes. The data showed a greater than three-fold
    increase in community-associated infections
    between 2009 and 2014.
  • Source Infection Control Hospital Epidemiology
    October 2015 (online pub)

3
MSSA Infection in Infants
  • Invasive methicillin-susceptible Staphylococcus
    aureus (S. aureus) infection (MSSA) caused more
    infections and more deaths in hospitalized
    infants than invasive methicillin-resistant S.
    aureus infection (MRSA), which suggests measures
    to prevent S. aureus infections should include
    MSSA in addition to MRSA, according to an article
    published online by JAMA Pediatrics. Researchers
    coauthors compared demographics and mortality of
    infants with MRSA and MSSA at 348 neonatal
    intensive care units (NICUs) around the United
    States to determine the annual proportion of S.
    aureus infections that were MRSA and to contrast
    the risk of death after invasive MRSA and MSSA
    infections. The authors identified 3,888 of
    887,910 infants (0.4 percent) with 3,978 invasive
    S. aureus infections. Infections were more
    commonly caused by MSSA (2,868 of 3,978 or 72.1
    percent) than MRSA (1,110 of 3,978 or 27.9
    percent). More infants with invasive MSSA
    infections (n237) died before hospital discharge
    than infants with invasive MRSA infections
    (n110). However, the proportions of infants who
    died after invasive MSSA and MRSA infections were
    similar at 237 of 2,474 (9.6 percent) and 110 of
    926 (11.9 percent). The absolute numbers of
    infections and deaths due to MSSA exceed those
    due to MRSA. Consideration should be given to
    expanding hospital infection control efforts
    targeting MRSA to include MSSA as well. Future
    studies to better define the relationship between
    MSSA colonization and subsequent infection will
    help to clarify the importance of such
    interventions for preventing MSSA disease.
  • Source Aaron M. Milstone, MD, MHS et al. Burden
    of Invasive Staphylococcus aureus Infections in
    Hospitalized Infants. JAMA Pediatrics, October
    2015

4
Biologists discover bacteria communicate like
neurons
  • Biologists have discovered that bacteria are
    actually quite sophisticated in their social
    interactions and communicate with one another
    through similar electrical signaling mechanisms
    as neurons in the human brain. In a study
    published in this week's advance online
    publication of Nature, the scientists detail the
    manner by which bacteria living in communities
    communicate with one another electrically through
    proteins called "ion channels. All of our
    senses, behavior and intelligence emerge from
    electrical communications among neurons in the
    brain mediated by ion channels. Bacteria use
    similar ion channels to communicate and resolve
    metabolic stress. The discovery suggests that
    neurological disorders that are triggered by
    metabolic stress may have ancient bacterial
    origins, and could thus provide a new perspective
    on how to treat such conditions. But how bacteria
    use those ion channels remained a mystery until
    researchers embarked on an effort to examine
    long-range communication within
    biofilms--organized communities containing
    millions of densely packed bacterial cells. These
    communities of bacteria can form thin structures
    on surfaces--such as the tartar that develops on
    teeth--that are highly resistant to chemicals and
    antibiotics. The study found that biofilms are
    able to resolve social conflicts within their
    community of bacterial cells just like human
    societies. When a biofilm composed of hundreds of
    thousands of Bacillus subtilis bacterial cells
    grows to a certain size, the researchers
    discovered, the protective outer edge of cells,
    with unrestricted access to nutrients,
    periodically stopped growing to allow
    nutrients--specifically glutamate, to flow to the
    sheltered center of the biofilm. In this way, the
    protected bacteria in the colony center were kept
    alive and could survive attacks by chemicals and
    antibiotics. Source Nature Mag

5
Nurse used same 2 syringes on 67 employees
  • The message said the flu shot administered two
    days earlier at the workplace clinic held at
    Otsuka Pharmaceutical in West Windsor may have
    exposed recipients to HIV, Hepatitis B and
    Hepatitis C. They needed to get tested
    immediately, then tested again in four to six
    months. The infection-control lapse occurred
    Sept. 30 when a nurse inoculated 67 workers using
    just two syringes.
  • "I have not slept since I have found out. I am
    tired beyond belief," said one of the shot
    recipients, who provided the email to NJ Advance
    Media. "At first I viewed it as not a big deal.
    But then it starts hitting you HIV, Hepatitis C
    ... this is serious.
  • The bungled clinic came to light when someone at
    the company noticed something was amiss and
    reported it. The state Department of Health
    reportedly interviewed the nurse who gave the
    injections that night. The U.S. Centers for
    Disease Control and Prevention also was notified.
  • The Department of Health then informed the state
    Board of Nursing temporarily surrender the LPN
    license she'd held for 30 years pending further
    action against her.
  • Source www.advisen.com

6
Lung Infection Outbreak Linked to Hospital Water
Supply
  • A Mycobacterium abscessus outbreak among lung
    transplant patients at a single hospital was
    traced to new building construction and its
    tainted water supply. M. abscessus infections
    were confirmed in 39 recently hospitalized lung
    transplant patients, the source of which was
    traced to 12 tap water supply locations in the
    ward, prompting the use of sterile water and a
    new antibiotic prophylaxis regimen, including
    imipenem and inhaled amikacin, to manage the
    outbreak. A new medical tower that had largely
    ICU beds and began to serve patients in late
    2013...lead to an amplification event where the
    concentration of M. abscessus grew past a certain
    threshold, but those isolates were present before
    the construction and opening of the building.
    Mycobacterium abscessus, and all rapid growing
    mycobacteria, can be problematic for hospitals,
    because they're ubiquitous in the environment.
    They're in the soil, they're in the water supply,
    and always a concern when you're building a new
    building -- potential contamination of the water
    to patients who could be at risk to acquire
    infections. From August 2013 through May 2014,
    the incidence rate was 3.9 cases per month, but
    that rate dropped back down to an average of 1.0
    cases per month after the implementation of
    intervention in June 2014 through March 2015
    (incidence rate ratio 0.26, 95 CI 0.13-0.51,
    Plt0.0001). In 92 of the patients, M. abscessus
    was first isolated in the respiratory tract. The
    researchers took cultures from environmental
    biofilms from 73 water sources in the hospital.
    These included patient room faucets and shower
    heads, ward faucets, and ice machines. Out of
    those 73 source environmental cultures, 12, or
    16, grew M. abscessus. Source Baker AW, et al
    "A cluster of mycobacterium abscessus among lung
    transplant patients investigation and
    mitigation" IDWeek 2015 Abstract 627.

7
UV Light Cut C. diff Transmissions by 25 Percent
on Oncology Floors
  • New research from Penn Medicine infection control
    specialists found that ultraviolet (UV) robots
    helped reduce the rates transmission of the
    common bacterial infection known as Clostridium
    difficile among cancer inpatients - mostly blood
    cancer patients, a group more vulnerable to
    hospital-acquired infections - by 25 percent. The
    interventions also saved about 150,000 in annual
    direct medical costs. The data was presented at
    the annual ID Week meeting by David Pegues, MD,,
    a professor of Infectious Diseases in Penn's
    Perelman School of Medicine and a healthcare
    epidemiologist in the Hospital of University of
    Pennsylvania's Infection Prevention and Control
    (Abstract 1715). UV robots flash UV lights
    across the room to lock onto DNA of organisms and
    kill them. The team found that using a
    ultraviolet germicidal irradiation robot after a
    room cleaning by EVS not only reduced the number
    of infections in cancer patients compared to the
    year prior with no robot, but did so without
    adversely impacting room turn around. They also
    report that infections increased by 16 percent on
    units without the robot during the study period.
  • C. diff aren't as deadly as other bacteria, but
    they are harder to clean away. They forms spores
    that are resistant to many disinfectants and can
    persist in the hospital environment for months.
    Approximately 500,000 people contract C. diff
    while in the hospital every year in the U.S., and
    nearly 15,000 die directly from the infection.
    Cancer patients, whose immune systems may be
    compromised from stem cell transplants and/or
    chemotherapy, are more susceptible to infections
    than other inpatients.

8
MRSA How you can avoid NFL player Daniel Fells'
plight at the gym
  • Daniel Fells, the 32-year-old Giants tight end,
    is fighting a serious MRSA type of staph
    infection that may lead to amputation, and will
    almost certainly end his career. Fells trouble
    began with an ankle injury, for which he received
    a cortisone shot. He was taken to the emergency
    room on October 2 with a fever of 104 degrees he
    has been in the ICU since Friday (October 9), and
    has already had five surgeries, according to an
    NFL report. A number of prominent NFL players
    have had MRSA infections, including members of
    the Browns, Redskins, and Rams. The Buccaneers'
    had an outbreak among three players and now faces
    a lawsuit from former kicker Lawrence Tynes, who
    claims that unsanitary conditions at the team's
    facilities caused him to become infected with
    MRSA, which required multiple surgeries and six
    weeks of intravenous antibiotics to cure. Tynes
    says this infection has ended his career, costing
    him over 20 million in anticipated future
    earnings. These Staphylococcal infections occur
    regularly with contact sports, especially with
    wrestling and football, because the close,
    skin-to-skin contact can infect abrasions from
    artificial grass (turf burns) or cuts the
    athlete's might already have from the rough
    sports.
  • Fells' infection, reportedly occurring after a
    cortisone shot into the joint, is uncommon. Knees
    are more commonly injected with steroids than
    other joints infection following knee injection
    ranges from 1 in 3,000 to 1 in 5,000.
  • Source http//www.forbes.com/sites/judystone/2015
    /10/13/how-you-can-avoid-daniel-fells-mrsa-plight/

9
Methicillin-Susceptible, Vancomycin-Resistant
Staphylococcus aureus (VRSA)
  • Acquisition of high-level vancomycin resistance
    by Staphylococcus aureus represents a major
    public health risk because this antimicrobial
    drug continues to be the first-line and most
    inexpensive therapy to treat methicillin-resistant
    S. aureus (MRSA) despite concerns about its
    clinical efficacy.
  • Vancomycin-resistant MRSA (VR-MRSA) was recovered
    from the bloodstream of a patient in Brazil .
    VR-MRSA belongs to sequence type (ST) 8 and is
    phylogenetically related to the
    community-associated (CA) MRSA USA300 genetic
    lineage that has rapidly disseminated in the
    United States and the northern region of South
    America (USA300-Latin American variant
    USA300-LV).
  • The vanA gene cluster in VR-MRSA was carried by a
    transferable staphylococcal plasmid (pBRZ01).
  • A clinical isolate of vancomycin-resistant,
    methicillin-susceptible S. aureus (VR-MSSA)
    exhibited the in vivo transfer of the vanA gene
    cluster to 2 unrelated S. aureus strains causing
    bacteremia within the same patient.
  • www.cdc.gov

10
CMS Inspectors find Mission Hospital, Orange
County, CA in crisis
  • The Mission Hospital Regional Medical Center in
    Orange County, CA, experienced deadly infections
    after joint surgery, a federal CMS inspection
    report shows. The report provides a rare,
    unobstructed look at conditions inside the
    private nonprofit hospital, which risked losing
    its accreditation last year over a small but
    severe outbreak of infections related to hip and
    knee surgeries. Mission Hospital is one example
    of how hospitals, even some with shining
    reputations and awards and special
    certifications, can fail to follow protocols
    aimed at preventing dangerous infections that can
    easily start and spread inside their facilities.
    At some of the other big hospitals in Orange
    County, problems ranged from bad hand hygiene to
    rusty procedure tables to a dirty diaper strewn
    on the floor of a neonatal intensive care unit, a
    Register review of CMS inspection reports from
    the past five years has found. The Register
    reviewed the reports on Mission Hospital and
    others following the outbreak at Mission
    Hospital, where four patients developed serious
    and unusual infections following hip and knee
    replacement surgeries in May and June 2014. For
    about two weeks in October, the hospital closed
    operating rooms under pressure from regulators as
    it scrambled to find the source of that outbreak.
    The infection control department was
    short-staffed and under-funded. The hospital
    employed one full-time infection control doctor
    and a part-time consultant - not enough to
    "provide oversight of the infection control
    practices" at a hospital, which has two campuses
    in Mission Viejo and Laguna Beach with 533 beds
    and that performs about 7,000 surgeries a year.
    http//www.ocregister.com/articles/hospital-684860
    -mission-operating.html

11
Contaminated Bronchoscopes Linked in 2014 to A
Potential Superbug Outbreak
  • While generally not publicly known, contaminated
    bronchoscopes, like duodenoscopes, are also prone
    to transmitting deadly superbug infections.
  • This is a particularly troubling finding, because
    health officials have publicly concluded that the
    complexity of the duodenoscopes design namely,
    its complex forceps elevator mechanism, which is
    challenging to clean is primarily responsible
    for the nations recent spate of outbreaks of CRE
    (and their related superbugs).
  • Moreover, not just duodenoscopes, but other types
    of GI endoscopes featuring an exposed elevator
    wire channel namely, linear echo-endoscopes
    might also be difficult to clean and pose an
    increased risk of CRE transmission. But,
    bronchoscopes, in contrast, do not feature a
    forceps elevator mechanism. Instead, they are
    much simpler in design and easier to clean than
    GI endoscopes, especially duodenoscopes. To
    date, health officials have not publicly
    cautioned the public about the risk of outbreaks
    of CRE following bronchoscopy. In December 2014,
    Olympus filed a medical device report, or MDR,
    documenting that contaminated bronchoscopes can
    transmit CRE to patients. According to this filed
    report, 14 patients tested positive for
    (meaning they were either infected or colonized
    with) a carbapenem-resistant strain of Klebsiella
    pneumoniae (i.e., CRE) after having undergone
    diagnostic bronchoscopy.
  • Source http//www.latimes.com/business/la-fi-fda-
    scope-infections-20150917-story.html

12
Ebola Virus Disease in Health Care Workers
Guinea, 2014
  • An outbreak of Ebola virus disease (Ebola) began
    in Guinea in December 2013 and has continued
    through September 2015 (1). Health care workers
    (HCWs) in West Africa are at high risk for Ebola
    infection owing to lack of appropriate triage
    procedures, insufficient equipment, and
    inadequate infection control practices (2,3). To
    characterize recent epidemiology of Ebola
    infections among HCWs in Guinea, national Viral
    Hemorrhagic Fever (VHF) surveillance data were
    analyzed for HCW cases reported during January
    1December 31, 2014. During 2014, a total of 162
    (7.9) of 2,210 laboratory-confirmed or probable
    Ebola cases among Guinean adults aged 15 years
    occurred among HCWs, resulting in an incidence of
    Ebola infection among HCWs 42.2 times higher than
    among non-HCWs.
  • The disproportionate burden of Ebola infection
    among HCWs taxes an already stressed health
    infrastructure, underscoring the need for
    increased understanding of transmission among
    HCWs and improved infection prevention and
    control measures to prevent Ebola infection among
    HCWs. Cases of Ebola infections among HCWs during
    this outbreak were first reported in January
    2014. The highest number of Ebola case
    notifications in HCWs in Guinea in a single week
    occurred during week 51 with 15 cases. This also
    corresponded to the week with the highest number
    of total Ebola cases (HCW and non-HCW) in Guinea
    during 2014.
  • Source MMWR October 2, 2015 / 64(38)1083-1087

13
Measles Outbreak Associated with Vaccine Failure
in Adults
  • Beginning on February 16, 2014, several patients
    were evaluated at Kosrae State Hospital for acute
    onset of fever and rash. No history of travel or
    specific disease exposures was available in the
    hospital records. Initial clinical diagnoses were
    dengue fever or chikungunya. However, during the
    next several months, as more persons with fever
    and rash were examined at the hospital, measles
    was considered as a possible diagnosis. On May
    15, serum samples collected from two persons with
    fever and rash had tested positive for
    measles-specific immunoglobulin M (IgM)
    antibodies. During February 16June 10, a total
    of 139 measles cases were detected in Kosrae
    through febrile rash illness surveillance at the
    hospital, contact tracing, and a retrospective
    investigation of earlier fever and rash cases.
    The first measles cases in Pohnpei were detected
    on May 12, and during May 12August 31, 251 cases
    were reported. The first case in Chuuk was
    detected on July 24 three cases were reported
    there during July 24August 26 (rash onset date
    could not be confirmed for one patient). This
    resulted in a total of 393 measles cases from the
    three states. Among the 393 measles patients,
    306 had vaccination records and the remaining 87
    were classified as having unknown vaccination
    status including 74 adults. Among those with
    vaccination records, 216 (71) had received at
    least one MCV dose before the outbreak, including
    169 (96) of adults aged gt19 years. Among adult
    patients with vaccination records, 123 (70) had
    received 2 doses of MCV. Among the 90
    unvaccinated patients, 54 (60) were aged lt12
    months and therefore ineligible for routine
    vaccination. Among 89 children and adolescents
    aged 119 years with measles, 29 (33) were
    unvaccinated seven (3) adults were
    unvaccinated. Source MMWR October 2, 2015 /
    64(38)1088-1093

14
Autopsy shows fungal infection played role in
death of UPMC patient
  • An autopsy of a Pittsburgh-based UPMC heart
    transplant patient revealed that a fungal
    infection played a role in her death. This
    contradicts UPMC's claims that the deaths of
    three transplant patients at UPMC Presbyterian
    and Montefiore hospitals could not be directly
    attributed to fungal infections possibly linked
    to mold found in the facilities.
  • After UPMC discovered that four transplant
    patients suffered fungal infections within a year
    span, the system temporarily closed its
    transplant program to seek a source of the
    infection. While mold was found in one of UPMC
    Presbyterian's intensive care units, an
    investigation did not yield a definitive source
    of the fungal infections. Pittsburgh-based UPMC
    resumed the transplant program at its
    Presbyterian and Montefiore hospitals on Sunday
    after voluntarily shutting down its organ
    transplant program last week when it linked a
    mold problem to four patients who developed
    infections, three of whom died.
  • The report also notes the following organizations
    will be monitoring UPMC's follow-up actions The
    Health Resources and Services Administration, the
    Organ Procurement and Transplantation Network,
    the United Network for Organ Sharing and a
    division within CMS. Source http//www.beckersho
    spitalreview.com/quality/transplant-program-reopen
    s-at-upmc-presbyterian-and-montefiore.html

15
New Legionnaires Outbreak in the Bronx Claims
a Life
  • One of the people sickened in a new outbreak of
    Legionnaires disease in the city has died,
    health officials said Wednesday. The Department
    of Health and Mental Hygiene released few details
    about the person, saying only that the patient
    was between the ages of 40 and 49 and had severe
    underlying health conditions. The city also
    said the number of people sickened by the
    outbreak, which is centered in the Morris Park
    section of the Bronx, had risen to 13, including
    the person who died. Of those, 11 are
    hospitalized and one has been released.
    Legionnaires disease, a type of pneumonia,
    killed 12 people in the South Bronx this summer
    and sickened more than 100 others. City officials
    said they believed it spread through vapor
    released from a water-cooling tower atop a
    building there. Health officials have said the
    group of cases in Morris Park is unrelated to the
    earlier cluster. They said they began
    investigating the Morris Park cluster last week,
    sending teams of investigators to test 35 cooling
    towers in the area. Of the cooling towers
    sampled, 15 tested positive for the bacterium,
    all of which were ordered by the city to be
    disinfected. At least six of the water-cooling
    towers that tested positive for Legionella
    bacterium are associated with the Albert Einstein
    College of Medicine. The college issued a
    statement saying it had complied with the new
    city law. Source http//www.wsj.com/articles/new-
    legionnaires-outbreak-in-the-bronx-claims-a-life-1
    443643340?tesla

16
Reduction in CDI in the ICU with UV Room
Decontamination
  • UV light for room disinfection (UVD) has been
    shown to eradicate methicillin-resistant
    Staphylococcus aureus, vancomycin-resistant
    enterococci, Acinetobacter, and C. difficile
    under the artificial conditions of inoculating
    surfaces with bacteria, exposing the bacteria to
    UV light and then culturing the surface.
  • The use of ultraviolet disinfection during
    hospital discharge could reduced the incidence of
    ICU-associated Clostridium difficile infection,
    according to recently published data. To further
    test UVD in a clinical setting, researchers
    examined its first year of implementation at
    Westchester Medical Center, a tertiary care
    hospital with 180 ICU beds in Valhalla, New York.
    UVD was performed after discharge with UV light
    after standardized procedures. For each case of
    C. difficile infection, data concerning the
    patients lengths of stay, the rooms they
    occupied and the rate of hospital- and
    community-associated C. difficile infection were
    collected. Analysis was performed, comparing the
    first year of UVD procedures (July 2011 through
    June 2012) and a similar period of time before
    implementation (May 2010 through April 2011).
    Hospital-associated C. difficile was reduced by
    22 during the period of UVD implementation (RR
    0.78 95 CI, 0.61-1.009). When examining adult
    ICU cases alone (n 60), researchers observed a
    much more significant reduction in C. difficile
    infection of 70 among UVD patients (P lt .001).
  • Source Nagaraja A, et al. Am J Infect Control.
    2015doi10.1016/j.ajic.2015.05.003.

17
Rare Salmonella Strain Sickens 14 Patients at
Henry Ford Hospital
  • The mysterious infection that sickened 14
    patients last week at a hospital in Michigan was
    caused by a rare bacterial strain called
    Salmonella Isangi. Officials of Detroits Henry
    Ford Hospital are not saying much about the
    outbreak, like how the patients contracted the
    Salmonella and whether the source of the bacteria
    has been identified, causing speculation to
    mount.
  • Salmonella infections are often traced to
    contaminated food or water. Yet, Salmonella can
    be transmitted basically by anything that enters
    your mouth, whether its a dirty hand, touching
    something that has Salmonella and touching your
    mouth, or food.
  • Typical symptoms include nausea, vomiting,
    diarrhea and abdominal pain. If it gets more
    severe, they can develop a fever and ultimately,
    it can become bloody diarrhea. The hospital acted
    immediately by restricting the patients by
    identifying them, by treating them and by
    preventing any further spread. So they reacted to
    this issue as quickly as possible and as
    efficiently as possible.
  • The seven patients that have been released are
    not a threat to anyone around them. As for the
    others still in the hospital, they could still be
    there because of what brought them there in the
    first place. No publicized reports or findings
    suggest that Henry Fords outbreak last week is
    linked to any type of contaminated medical
    instrumentation.
  • Source http//www.clickondetroit.com/news/14-pati
    ents-diagnosed-with-salmonella-at-henry-ford-hospi
    tal/35566506

18
A cloud of bacteria follows you around
  • According to a study published in PeerJ, each of
    us is surrounded by a cloud of bacteria every
    second of our lives. These microbial companions
    are so unique that the cloud might be as
    identifiable as your fingerprint. The study was
    relatively small - just 11 participants - but it
    brings evidence that our microbial footprints may
    be as good as an actual footprint at identifying
    us. Researchers put the subjects inside a
    sanitized chamber for 90 minutes, then tested the
    cloud of microbes each subject left behind.
    Previous research found that we put our microbial
    footprint into the room we've just entered
    relatively quickly, with your house having
    different mircobiomes than your office or the
    hotel room you spent a vacation in. The subjects
    left behind plenty of common, human-associated
    microbes, but the ratios of these microbes were
    unique enough that researchers were able to
    identify nearly all of the subjects just based on
    their microbial footprints.
  • The most interesting aspect of the study may be
    the implications it has on forensic evidence used
    in crimes. As anyone who has watched CSI knows,
    DNA evidence can lead to a solid guilty or
    innocent verdict in a crime. But sometimes there
    is no DNA, so with what we know about microbial
    footprints, forensic analysts may turn to the
    microbial clouds for evidence. A study last year
    suggested microbial footprints may be used in
    sexual assault cases if there is an absence of
    DNA. In Hawaii, a different group is trying to
    figure out if microbes left on or around homicide
    victims could tie a suspect to the crime.
  • Source Meadow, J, et al. Humans differ in their
    personal microbial cloud. PeerJ . 2015

19
Does NICU bed configuration affect sepsis, MRSA
rates?
  • Researchers compared rates of colonization by
    methicillin-resistant Staphylococcus aureus,
    late-onset sepsis and mortality in single-patient
    neonatal intensive care unit rooms and open-unit
    rooms in a recent study published in the journal
    Infection Control Hospital Epidemiology.
  • The study was conducted in the NICU of a tertiary
    referral center which was organized into
    single-patient and open-unit rooms. Clinical data
    sets including bed location and microbiology
    results were then examined over the next 29
    months. Of the more than 1,800 patients studied,
    single-patient and open-unit models had similar
    incidences of MRSA colonization and MRSA
    colonization-free survival times. Late-onset
    sepsis rates were also similar in single-patient
    and open-unit models, as were sepsis-free
    survival rates and the combined outcome of sepsis
    or death.
  • Ultimately, the researchers concluded
    single-patient rooms did not reduce the rates of
    MRSA colonization, late-onset sepsis or death.
    However, they did discover the NICU's MRSA
    colonization rate was impacted by hand hygiene
    compliance, regardless of room configuration.
  • Source Infection Control and Hospital
    Epidemiology Oct 2015

20
FDA orders duodenoscope manufacturers to conduct
postmarket surveillance studies in health care
facilities
  • The U.S. Food and Drug Administration today
    ordered the three manufacturers of duodenoscopes
    marketed in the U.S. to conduct postmarket
    surveillance studies to better understand how the
    devices are reprocessed in real-world settings.
    The three manufacturers Olympus America, Inc.,
    Fujifilm Medical Systems, U.S.A., Inc., and Hoya
    Corp. (Pentax Life Care Division) that market
    duodenoscopes sold in the U.S will have 30 days
    to submit postmarket surveillance plans to the
    FDA. These proposals must detail their plans to
    conduct studies to evaluate, among other things,
    how well health care personnel are following
    instructions to clean and disinfect duodenoscopes
    between patients and to better understand the
    rate of contamination of clinically used
    duodenoscopes. These studies are based on the
    FDAs current understanding of factors that may
    be contributing to infection outbreaks following
    endoscopic retrograde cholangiopancreatography
    procedures (ERCP), as well as the information
    needed to help fill gaps in knowledge. The goal
    of these studies is to collect useful data about
    the effectiveness of current reprocessing
    instructions and practices that can provide the
    FDA with information necessary to protect the
    public health, including taking action to help
    reduce the risk of duodenoscope infections.
    http//www.fda.gov/NewsEvents/Newsroom/PressAnnoun
    cements/ucm465639.htm

21
Bubonic Plague in Michigan
  • A Michigan resident recently became the 14th
    person this year to contract the plague, the same
    disease that was responsible for the Black Death
    pandemic in Europe in the 1300s. Although the
    plague has never officially been eradicated,
    instances of infection usually remain low in the
    U.S., averaging around seven cases per year. The
    14 reported cases have been mostly of the bubonic
    form of the plague, which is spread to humans
    through fluids from infected rodents or flea
    bites. The plague consists of three forms
    bubonic, pneumonic and septicemic, with the
    bubonic plague being the cause of 80 percent of
    plague cases in the U.S. The Michigan resident
    was diagnosed with bubonic plague, which cannot
    be spread from person to person. The only form
    that can be transmitted from person to person is
    the pneumonic plague because it affects the lungs
    and can be spread through coughing.
  • The septicemic form of the plague is the rarest
    and occurs when the plague spreads to the
    bloodstream. This rare form was the cause of
    death in June for a Colorado teenager, who was
    believed to have been infected by a flea bite on
    his parent's rural ranch in Colorado. The
    Michigan woman who came down with the bubonic
    plague was also infected in Colorado during a
    camping trip. A possible contributing factor is
    the drought that is occurring throughout the
    West. Rodents may be flocking to campgrounds in
    search of food, and fleas may be biting humans
    more as they jump onto humans from dying animals.
    But those traveling out west to a rural area
    hunters should use gloves when handling animals,
    wearing long sleeves and bug spray containing
    DEET for those going camping. Any animals brought
    along on the trip should be treated with flea
    control products. www.cdc.gov

22
Should Doctors Go Bare? Infection Control Debate
Rages
  • HAIs and the rise of MDROs has put new focus on
    whether requiring doctors to go bare below the
    elbows (BBE) would help infection control. BBE
    means no long sleeves, no neckties, no
    wristwatches, no jewelry other than a wedding
    band, and generally that physicians will wear
    scrubs. The practice was adopted in the UK in
    2008. But it appears to be a tough sell in the
    US. At a debate today at IDWeek 2015 in San
    Diego, two physicians squared off in a
    friendlyand highly entertainingdebate.
    Michael Edmond, MD, MPH, MP,of the University of
    Iowa Hospitals and Clinics said his hospital is
    going BBE January 1, 2016. He took the yes
    side of the debate. Neil Fishman, MD, of Penn
    Medicine in Philadelphia, PA, took the no side
    and closed his debate with a hip-hop style rap.
  • Edmond began by citing studies that showed how
    dirty and microbe-contaminated lab coats could
    get. Though some surveys have shown patients
    prefer to see their doctors in coats and ties,
    Patients preferences vary and the survey
    techniques may bias the answers, he said. In a
    straw poll after the debate, the audience sided
    58 to 42 with Fishman. Edmond said he was
    convinced that BBE would help infection control
    since staph and other organisms persist on
    clothing, lasting over a month on white coats,
    particularly if they are polyester not cotton.
    Source Forbes Magazine Article

23
Ebola Nurse Critical Sneezing Every Second
  • A nurse who contracted Ebola while working in
    West Africa is now "critically ill" with
    complications arising from the infection. Pauline
    Cafferkey was readmitted to a specialist
    isolation unit at the Royal Free Hospital in
    London last week.
  • The hospital said in a statement that her
    condition had deteriorated. Ms Cafferkey, 39,
    from Cambuslang in South Lanarkshire, contracted
    Ebola while working at a treatment centre in
    Sierra Leone last year. She spent almost a month
    in isolation at the Royal Free at the beginning
    of the year after the virus was detected when she
    arrived back in the UK. She was later discharged
    after apparently making a full recovery, but it
    was discovered last week that Ebola was still
    present in her body. Bodily tissues can harbour
    the Ebola infection months after the person
    appears to have fully recovered. When the
    desperate call for health workers came at the
    height of the Ebola outbreak, Pauline Cafferkey
    stepped up to the very risky challenge. Whilst
    most were keen to be as far away as possible from
    the epidemic, Pauline ran right into the centre
    of it. Ms Cafferkey had initially gone to an
    out-of-hours doctor in Glasgow on Monday of last
    week, but was sent home after being told she
    probably had a virus. Her family has claimed
    doctors "missed a big opportunity" to spot she
    had fallen ill again. She was admitted to the
    city's Queen Elizabeth University Hospital the
    following day after continuing to feel unwell,
    before being transferred to the Royal Free in a
    military aircraft on Friday morning. She was
    admitted on Friday morning when her condition was
    serious and it is now critical.
  • Source http//www.bbc.com/news/uk-scotland-345295
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